1. Field of the Invention
The present invention relates generally to methods and systems for processing billing records and, more particularly, to methods and systems for processing professional and technical medical billing records.
2. Related Art
Medical facilities use medical billing systems to collect and process information needed to prepare claims relating to medical care provided to patients. These claims are submitted to payers such as insurance companies, Medicare, and patients. Many medical facilities, especially outpatient clinics in hospitals, use “split billing” charge practices. Split billing refers to the practice of providing technical charges to a payer separately from professional charges for each patient encounter at the medical facility. Professional charges refer to charges for services rendered by physicians and other professional medical providers for each patient encounter. Technical charges refer to charges for use of facilities, clinical staff time, procedures performed by clinical staff, medications, and supplies used in the course of care for a patient.
Clinical staff members of the medical facility are typically responsible for documenting technical charges. Clinical staff includes nurses, medical assistants, and other personnel who interact with patients and deliver services that are billable as technical charges.
The technical charges for a patient encounter are usually closely related to the professional charges. Typically, all professional charges have a corresponding technical component. For example, procedures performed by a physician at the medical facility typically involve technical charges for use of facilities, staff time, and medications and other supplies used in the procedure. Even in an evaluation and management (E/M) visit, activities such as use of an examination room, chart preparation, and patient education can typically be billed as technical charges. Because the technical charges are closely related to the professional charges, attempts are made to document these charges together for each patient encounter.
Billing codes are used in medical billing records to represent details of medical charges. The billing codes used in professional billing records are generally standardized in the industry. Commonly used professional billing code lists include CPT-4 codes (Current Procedural Terminology, Version 4—maintained by the American Medical Association), HCPCS (Healthcare Common Procedure Coding System) codes, and ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) codes.
Technical billing codes, however, are not generally standardized and vary among medical institutions. The technical billing codes are typically maintained by each institution in a so called charge description master (CDM) database, which is also called a Charge Master. Each code in the Charge Master typically identifies the medical charge and the part of the medical institution to which the charge should be attributed. (Medical institutions typically have multiple departments and groups.) The Charge Master codes also specify unit prices for each type of service, medication, or product used in providing care. There are typically tens of thousands of CDM codes.